End-of-life stages and signs

Caring for communities

If your loved one has a terminal illness, knowing death is near can be hard to process. Understanding the end-of-life stages can help you better understand their journey and how you can best support them through each stage.

The transformation that occurs at the end of life is similar to that of a caterpillar to a butterfly. Learn more about the unique physical, mental and emotional signs of each transformational stage below.

Caterpillar stage

It’s common for many people to move through life focused on daily tasks and rushing through schedules, meals and appointments. Acknowledging a terminal diagnosis causes us to pause and go back to the basics.

In this stage, your loved one is focused on survival, growth, consumption and managing basic needs. This stage gives caregivers time to focus and prepare, while also giving time and attention to your loved one’s needs.

Signs of death: 1-3 months before

PhysicalFatigued; loss of appetite; preference for liquids; unable to tolerate strong smells or odors
MentalMore aware of limitations and declining health; confusion; self-centeredness; begins discussing finances, wills or other plans
EmotionalDenial or anger about diagnosis; withdrawal; reminiscing on favorite memories; desire more touch and caring

Chrysalis stage

During this stage, your loved one builds a sheltered, safe location called a chrysalis. This creates a protective cover for where their transformation will take place.

It’s common for those facing a terminal illness to focus on resolution during this stage. Be open and inviting to these discussions with your loved one if you begin to notice these signs.

Signs of death: 1-2 weeks before

PhysicalDifficulty waking-up or keeping eyes open; changes in skin temperature; lack of appetite; restless or agitated; picking at bedding, clothing or the air
MentalDifficulty concentrating; confusion; difficulty recognizing friends or family; regressing to an earlier time; asking if they are dying
EmotionalHaving more spiritual questions; wanting to say goodbye to family and friends; openly speaking about death; expressing fear about dying; speaking to people who have already passed; vivid dreams

Butterfly stage

In the final end-of-life stage, your loved one requires rest and energy before it can emerge from the chrysalis. They are focused on releasing and letting go.

It is important for family and friends to provide words of comfort, reassurance and most importantly, permission to let go during this stage.

Signs of death: 2 days – a few hours before

PhysicalIncreased energy or clarity; increased appetite; changes to skin color; holding eyes half open but fixated; changes in blood pressure and pulse
MentalAwareness of surge of energy; desire to have conversations with loved ones OR non-responsive to communication attempts; unable to talk
EmotionalDesire to say goodbye; using travel phrases (“I need to get going” or “It’s time for me to go home”); talking about the light, a tunnel or angels; talking about early life

Free at last, the butterfly emerges, spreads their wings and flies. Grief and sadness are a normal part of grieving, but allow the image of a butterfly to comfort you as you remember their journey.

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